Introduction► Between one-third to one-half of the child admitted hospital for acute abdominal pain have non-specific abdominal pain.► Another one-third have acute appendicitis.► Other relatively benign condition also cause abdominal pain such as constipation, urinary tract infection account for most of remain.
Work-up Of child with Acute Abdominal Pain► A careful history and examination and active observation are paramount.► Routine test include urine analysis, microscopy and culture.► Frequently helpful tests such as abdominal ultrasound scan can diagnose pelvic, UTI and GIT pathology.► Occasionally helpful a plain supine radiograph particularly in preschool child with pain and vomiting, urea and electrolytes and CBC.► Selective specific investigation are blood culture, stool culture, plasma amylase and diagnostic laparoscopy.
Acute Non – Specific Abdominal Pain► Pain is poorly localized, not aggravated by movement and rarely accompanied by guarding.► Site and severity of maximum tenderness often vary during the course of repeated examination.► Symptoms are usually self limiting within 24h.► The etiology of non-specific pain in children is obscure but viral infection and transitient intussusception are account for some cases.► Mesenteric adenitis a viral infection causing widespread 1- Reactive lymphadenopathy 2- Fever 3- Diffuse Abdominal Pain.
Other Causes Of Acute Abdominal Pain► Intestinal Obstruction► Constipation► Urinary Tract Infection► Gastroenteritis► Tropical Disease► There are numerous rare cause of abdominal pain in children are 1- Henoch-schonlen purpura 2- Sickle Cell Disease 3- Primary peritonitis, acute pancreatitis and biliary colic 4- Testicular torsion and gynecological pathology 5- Urinary stone disease.
Intestinal Obstruction► Intestinalobstruction in children caused by► Intussusception► Inguinal Hernia► Adhesion► Meckel’s diverticulum
Constipation► The passage of hard or infrequent stool.► Constipation is more often cause acute abdominal pain when it is secondary to 1- Anal Fissure 2- Hirschsprung’s Disease 3- Anorectal malformation 4- Neuropathic bowl.► Rectal examination and plain abdominal radiography may helpful in severe cases.
Urinary Tract Infection► UTI is an uncommon cause of abdominal pain.► Urinary symptoms vomiting and fever tend to be predominant.► Definitive infection can be confirmed by urinalysis, microscopy and culture.► Sterile pyuria may accompany acute appendicitis► Child with pelviuretic junction obstruction present with acute or recurrent abdominal pain with no urinary symptoms.
Gastroenteritis► Itmay cause colicky abdominal pain.► Onset of pain before the diarrhea and presence of lower abdominal tenderness should raise suspicion of appendicitis.► Pelvic tenderness on rectal examination may be useful pointer to appendicitis.